The study will assess the cost-effectiveness of a bladder training therapy based on principles of behavior change for treating urinary incontinence among elderly persons. The procedures used are increasing fluid intake, prompting individuals to toilet at regularly scheduled intervals, reinforcing appropriate toileting behavior. The aims of the project are to (1) estimate the psychosocial, health, and resource costs of urinary incontinence among the elderly, (2) measure the clinical effectiveness of a bladder training therapy, (3) identify those factors which influence the effectiveness of the therapy, and (4) compare the cost and effectiveness of the bladder training therapy with management which is not based on bladder training. The project will be based on a randomized controlled trial in which 175 residents of three to four nursing homes in central Pennsylvania will be randomly assigned to either a bladder training group or a control group. Those exhibiting urinary incontinence will undergo a urological examination consisting of physical examination including pelvic and rectal examination, neurological evaluation, catheterization for residual urine and cystometrogram study. Much of the research design, recruiting protocol, bladder training protocol, and instrumentation have been refined in our current pilot study. The effectiveness of the bladder training will be measured with three outcomes. The first is changes in the prevalence of incontinence in terms of the frequency of incontinence episodes per day or per week, both before, during, and after the treatment program. The second measure is changes in personal, physical and psychological functioning expressed through physical assessment, such as health status, skin color, odor, physical activities, and psychological stress levels. The third outcome measure is changes in the required resources needed for the care of urinary incontinence. These resources are measured in terms of person hours spent and the amount of supplies used over the time period. The findings of this study will provide significant information for nursing professionals, policymakers, and the elderly.